Breast and cervical cancer screening for women with mental illness: patient and provider perspectives on improving linkages between primary care and mental health

7024 Background: Over a million Americans identify themselves as transgender and this population is growing. Transgender status was a pre-existing condition prior to the Affordable Care Act (ACA), and transgender individuals faced unique disparities in gender-specific cancer screening in part due to discrimination in health insurance coverage. Modern literature for transgender adults’ adherence to cancer screening is limited. To fill this knowledge gap, we conducted a cross sectional study to investigate transgender individuals’ self-reported adherence to cancer screening and access to primary care compared to cisgender individuals. Methods: The Behavioral Risk Factor Surveillance System database was queried for transgender (either male-to-female [MTF] or female-to-male [FTM]) and cisgender adults from 2014-2016 and 2018. Primary endpoints were adherence to breast and cervical cancer screening guidelines and access to primary health care. Those with prior hysterectomy, breast and cervical cancer were excluded. Multivariable logistic regression was performed to evaluate the association of transgender status with cancer screening and healthcare access, after adjusting for demographic characteristics and survey weights. Results: A total of 219,665 and 206,446 participants were eligible for breast and cervical cancer screening, respectively. Of those, 614 (0.28%) and 587 (0.29%) transgender participants were eligible for each cancer screening type, respectively, representing a weighted estimate of nearly 200,000 transgender participants total. When compared to cisgender counterparts, transgender participants were less likely to adhere to breast cancer screening (FTM: OR 0.47, p < 0.001; MTF: OR 0.04, p < 0.001) and to have received any breast cancer screening (FTM: OR 0.32, p < 0.001; MTF: OR 0.02, p < 0.001). Similarly, FTM participants were less likely to adhere to cervical cancer screening (OR 0.42, p < 0.001) and to have received any cervical cancer screening (OR 0.26, p < 0.001). In addition, transgender participants were more likely to have no primary care physician (FTM: OR 0.79, p < 0.001; MTF: OR 0.58, p < 0.001) and to be unable to see a physician when needed within the past year due to medical cost (FTM: OR 1.44, p < 0.001; MTF: OR 1.36, p < 0.001). Conclusions: Despite the implementation of the ACA, limited primary care access and poor adherence to breast and cervical cancer screening are evident for transgender populations. Further research efforts to improve the utilization of preventive cancer services are needed for this underserved population.

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Disparities in Breast and Cervical Cancer Screening in Women with Mental Illness

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2012.12.006 ◽

2013 ◽

Vol 44 (4) ◽

pp. 392-398 ◽

Cited By ~ 46

Author(s):

Arpita Aggarwal ◽

Ananda Pandurangi ◽

Wally Smith

Keyword(s):

Cervical Cancer ◽

Mental Illness ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Breast And Cervical Cancer

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323Breast and cervical cancer screening and outcomes in NSW mental health service consumers

International Journal of Epidemiology ◽

10.1093/ije/dyab168.710 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Elizabeth Wilson ◽

Hanna Tervonen ◽

David Currow ◽

Grant Sara

Keyword(s):

Mental Health ◽

Cervical Cancer ◽

Mental Illness ◽

Cancer Screening ◽

Mental Health Services ◽

Health Services ◽

Cervical Cancer Screening ◽

Cancer Mortality ◽

Mental Health Problems ◽

Research Translation

Abstract Focus of Presentation This presentation describes methods and findings from the NSW Mental Health Living Longer (MHLL) Program. MHLL involves population-wide data linkage that combines records from nine NSW data collections. Our collection includes over 120 million records for more than nine million people. This presentation focuses on the use of linked data to develop indicators to support reporting on premature cancer mortality for people living with mental illness. We will use these indicators to identify variation in care, assess areas for targeted intervention, and evaluate the effectiveness of research translation into safer and more effective care. Findings This work will be finalised by August 2020. We will use regression techniques to examine predictors of participation in breast and cervical cancer screening for women who use mental health services in NSW. These results will be used to assess geographical variation in risk-adjusted screening participation rates. We will also present methods and results for measuring incidence and stage at presentation, as well as 12 month and 5 year survival for women who use mental health services compared to other women in NSW. Conclusions/Implications If cancer survival is a key measure of the effectiveness of healthcare systems, then reduced survival in people with mental health problems reflects less effective health care. Improving screening and treatment services is likely to be the most important strategy for reducing the cancer mortality gap for people with mental illness. Key messages Health systems must move from recognition to action if we are to reduce premature cancer mortality in people living with mental illness.

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Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care

Medical Care Research and Review ◽

10.1177/1077558718771123 ◽

2018 ◽

Vol 77 (1) ◽

pp. 34-45 ◽

Cited By ~ 1

Author(s):

Lindsay M. Sabik ◽

Bassam Dahman ◽

Anushree Vichare ◽

Cathy J. Bradley

Keyword(s):

Primary Care ◽

Cervical Cancer ◽

Cancer Screening ◽

Managed Care ◽

Case Management ◽

Cervical Cancer Screening ◽

Physician Payment ◽

Breast And Cervical Cancer ◽

Screening Services ◽

The Relationship

Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states’ Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.

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